Special Testimony: Public Hearing on Reflexology Occupational Regulation
This special testimony was presented at a public hearing of the Nebraska's Department of Health and Human Services Reflexology Technical Review Committee. Learn more here about how this profession has faced regulatory barriers in Nebraska.
Good Afternoon. My name is Sarah Curry and I am the Policy Director at the Platte Institute. First, I want to say thank you for listening to this discussion and offering your opinion on the issue of Reflexology.
This issue was brought to my attention when my organization started working with lawmakers on occupational licensing reform. Occupational licensing laws were initially created as a means of protecting the public from negligent and unqualified practitioners, but more and more, instead of protecting the public from harm, we now understand that excessive occupational licensing is making it difficult for new workers to enter the workforce.
Currently, Nebraska law requires someone desiring to work solely as a reflexologist seek licensure as a massage therapist. This regulation imposes a significant economic hardship, has significantly diminished the supply of qualified reflexologists, and has created a barrier to offer this service that is not consistent with the public welfare and interest intent of occupational licensing.
The burden on reflexologists is not new, and this is not the first time the issue has been brought up in Nebraska. In 2009 a legislative bill was filed to exempt reflexology from the state’s massage law. This bill did not make it out of committee and the issue was brought up again in 2017 in legislative bill 588. Many of those that testified in support sent their testimony to the 407 committee and can be seen on the website. In both of these legislative hearings, the massage board has testified in opposition to this exemption. The sponsoring senator felt it was time to submit this question to the 407 review board, and that is why we are here today.
One of the supporting documents the opposition has used in both legislative testimony and the discussion before the 407 committee was a letter from the Nebraska Attorney General’s office in 1985 stating reflexology was considered massage. I have contacted the Attorney General’s office asking for details about this document and they have told me that it is not a formal opinion and just an internal government document. They also said the validity of this document is unknown because it was written 30 years ago and there have been many changes to the state statute since then, so they have no way of knowing if the information it includes is still valid. I have asked them to document this in writing and I am in the process of getting that to the committee.
The majority of the burden for reflexologists in Nebraska comes from the educational requirements. To become a reflexologist through private certification, one must receive 200-300 hours of training, depending on the program and level of expertise desired. To become a licensed massage therapist in Nebraska, however, one must complete a massage therapy program of at least 1,000 clock hours and pass either the National Certification Examination for Therapeutic Massage and Bodywork or the Federation of State Massage Therapy Board's Massage & Bodywork Licensing Examination. In addition, most of the massage education is how to massage someone, not on the specific technique of reflexology.
This means someone would have to commit an additional 9-20 months of education to complete the program with a financial obligation of $7,845 to $16,335 in tuition and fees depending upon which of the state’s programs one chose, and still not have the training necessary to do practice what they want to do.
This is even more burdensome because Nebraska has one of the most time-consuming massage laws in the nation, requiring hundreds more hours than many states. Asking reflexologists to comply with one of the most burdensome massage laws in the country has caused many to practice reflexology in secret in an effort to avoid the costly and time consuming education.
When I submitted my application, I wanted the 407 committee to tell me what level of regulation they thought was best for reflexologists. The Platte Institute is supportive of exempting reflexology from the massage law. It is evident from the two legislative hearings, and the discussions we had earlier in the 407 process, that a simple exemption is not possible in Nebraska. In the spirit of imposing the least burdensome requirement on reflexologists, we would support a registration, but again the massage board has voiced their concern against that. So I submitted to the committee an outline of a reflexology license in the hope of compromise with the massage board.
Even with this compromise of creating a new license, the massage board has again voiced their opposition. I don’t know where else to compromise, because leaving the situation as it currently stands is not fair to reflexologists and is proving that the massage board is using occupational licensing not to protect the public but to protect their own license and current practioners.
One thing I think this committee should not compromise on is the educational requirements for reflexologists. In an email to the committee from the Nebraska State Board of Massage Therapy they outlined their desired regulations which keep it similar to massage therapy. Why does a reflexologist need to match the educational requirements of any other profession?
If the concern is the safety of the public, wouldn’t the best education be a curriculum targeted specifically at the skill set needed for the practice of reflexology? Reflexology has a national membership association, a commission for accreditation of reflexology education and training, and national certification testing. I see no reason why a reflexologist needs to comply with the massage board’s educational requirements when they have their own curriculum that has been refined to target the specific needs of their field.
The differences between massage and reflexology was even acknowledged by the American Massage Therapy Association in 2003 when they issued a model state code proposal for new and revised massage legislation on a state level. This model law called for an exemption for reflexology and more specifically, “persons who restrict their manipulation of the soft tissues to the body otherwise to the hands, feet and ears and cannot hold themselves out as massage therapists or do massage.” This clearly demonstrates that those at the national level within the massage field recognize the difference between reflexology and massage.
And in addition to the AMTA recognizing the difference, over 30 states have exempted reflexology from their massage law. Only five states have their own reflexology regulations and 4 states have no massage law, meaning reflexology is not regulated or licensed. Among Nebraska’s neighboring states, Colorado, Iowa, Missouri, and South Dakota have all exempted reflexologists from a massage law. Two others, Kansas and Wyoming, of the surrounding states do not have a massage law at all.
Many of the subjects suggested by the Nebraska Massage Board are covered by the reflexology educational requirements to become national board certified, but they are done so with the main focus being reflexology, not massage. There is no need for the massage board to certify their schools or teachers, as reflexology schools and instructors already go through their own set of qualifications. There is no need for a state exam since there is already a national exam for board certification.
If the State of Nebraska is to move forward with licensure, then there needs to be consistent standards put into place allowing reciprocity with other states and the acceptance of the already established guidelines and educational requirements of reflexology on a national scale. If someone receives national board certification in reflexology, regardless of what state they are in, they should be able to come to Nebraska and practice reflexology. The average patient does not know which practitioners are qualified to provide services and which are not. That is why national industry groups that are already doing a good job of regulation in this area should be used when creating the regulatory framework for reflexologists in Nebraska.
Requiring that reflexologists become licensed would impose a significant financial burden on these providers, a burden that cannot be justified in terms of public health, safety, or welfare, given that there is no evidence of harm to the public. But in the spirit of compromise, a license for reflexology is still less of a burden than obtaining a massage license.